AccountId: 011433970860
ContactId: 1970aaea-4704-4002-8a85-53cb2a0931b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1045239 ms
Total Talk Time (AGENT): 283665 ms
Total Talk Time (CUSTOMER): 262091 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/1970aaea-4704-4002-8a85-53cb2a0931b0_20250519T16:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling for JLR Medical Group Anesthesia physical. Could you please spell your name, [PII]?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][POSITIVE] Thank you. And
[CUSTOMER][NEUTRAL] Mhm go ahead.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] I can definitely help you with claim status. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. [PII]. It's a direct line or any other extension?
[AGENT][NEUTRAL] OK [PII] and I'm sorry I didn't get the last four.
[CUSTOMER][NEUTRAL] [PII]. It's a direct line. There is no any other extension.
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Sure the member ID number here that's gonna be.
[CUSTOMER][NEUTRAL] 02120.
[CUSTOMER][NEUTRAL] 136 M as in Mike. L as in Lima number 8.
[AGENT][NEUTRAL] OK, one moment while I look that up for you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure. Patient's first name is [PII]. It's [PII]. Patient last name is [PII]. Patient date of birth is [PII].
[AGENT][POSITIVE] All right, thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And do you have the claim number or the date of service?
[CUSTOMER][NEUTRAL] Sure. The claim number is 3,530,320. And we already get the claim has been denied for outpatient benefit for this calendar year has been met. And could you please confirm that this is uh PR or coinsurance?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, give me one moment while I pull that claim up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, I am showing that that policy or I'm sorry that that claim was submitted on [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And yes, ma'am. The benefits, uh, it was denied due to outpatient benefits for that calendar year, um, had been met.
[CUSTOMER][NEUTRAL] It's a, a patient responsibility or provider right now. Can you please confirm that?
[AGENT][NEUTRAL] If it was denied, um, it would be on the patient.
[CUSTOMER][NEUTRAL] Patient, OK. And we need to build the total amount for the patient, $429.52.
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the provider's name?
[CUSTOMER][NEUTRAL] Sure, the individual provider name, sure that's gonna be.
[CUSTOMER][NEUTRAL] It's an
[CUSTOMER][NEUTRAL] Davidson
[AGENT][NEUTRAL] Or the, do you have the hospital group, the hospital name?
[CUSTOMER][NEUTRAL] JLR Medical Group anesthesia.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And we are also using another name, anesthesia Partners of Florida INC.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so that would go to the patient. And then what was the other question you had? I'm so sorry.
[CUSTOMER][NEUTRAL] Sure. And do you have the mid date?
[AGENT][NEUTRAL] The date of service?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] The benefitmid date. Do you have that?
[AGENT][NEUTRAL] Um, I can check.
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEGATIVE] No, I'm unable to pull that up as it wasn't with that provider.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah I will see the provider name on your end?
[AGENT][NEUTRAL] It was the provider that you gave me, the JLR.
[AGENT][NEUTRAL] JLR Medical group, right. And if it's not um a claim from them, I can't give information on it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] DeLR is a facility name. It's a medical group name and the provider and Davison.
[AGENT][NEUTRAL] Yeah, I'm, I'm showing JL JLR Medical Group um as the last benefit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That they had
[AGENT][NEUTRAL] But if they met their deductible or if they met their maximum, if it wasn't through your that medical group, I can't give that information out.
[CUSTOMER][NEUTRAL] What information do you need?
[AGENT][NEUTRAL] You were asking when they met the when they met their uh deductible or I'm sorry when they met their calendar max I can't give that since it wasn't through that provider.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Only you provided information.
[AGENT][NEUTRAL] I'm sorry you just broke up. Can you, can you repeat the question?
[CUSTOMER][NEGATIVE] I'm not understand what I'm saying right now.
[AGENT][NEUTRAL] OK, one.
[CUSTOMER][NEUTRAL] So you will be provided that information to uh only for the [PII] provider?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK sir. So we need to bill the patient for the amount of $429.52.
[AGENT][NEUTRAL] Yes, they, yes, the JLR Medical group will need to do that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] And I have the same age, sorry, uh I have uh another one patient here. Could you please assist me with other patient?
[AGENT][NEUTRAL] Sure. Give me one moment. Let me uh finish up with this patient.
[AGENT][NEUTRAL] Um, let me put my notes in for this patient and then I'll be able to help you with that other one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] I'm almost done.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] I apologize, give me just one more moment, OK?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what is the next policy number?
[CUSTOMER][NEUTRAL] Sure. The next patient number ID number, sir, that's gonna be.
[CUSTOMER][NEUTRAL] 19
[CUSTOMER][NEUTRAL] 476-48
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure. Patient's first name is [PII]. The last name is [PII]. Patient date of birth is [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] This claim be received and the claim has been denied for the service is not covered when performed in the doctor's office in the clinic?
[CUSTOMER][NEUTRAL] Is that right? And can you please confirm the
[CUSTOMER][NEUTRAL] Mhm. Go ahead.
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] 348-8343.
[AGENT][NEUTRAL] OK, let me look it up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, it looks like we.
[AGENT][NEUTRAL] Received that claim on [PII]. It was processed on [PII].
[AGENT][POSITIVE] And you're correct that service.
[CUSTOMER][NEGATIVE] And this claim has been denied for service is not good.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, so that.
[AGENT][NEUTRAL] That claim was denied because the service is not covered when it's performed in a doctor's office or clinic.
[AGENT][NEUTRAL] So under their policy.
[CUSTOMER][NEUTRAL] OK. Could you please provide me the mailing address?
[AGENT][NEUTRAL] Our mailing address?
[CUSTOMER][NEUTRAL] Just now you say something, go ahead with that.
[AGENT][NEUTRAL] Did you ask for our mailing address?
[CUSTOMER][NEUTRAL] No, I mailing address.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This is also with JLR Medical Group.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And you're wanting to know where this denial was sent. I'm so sorry it's, it's hard to hear you.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah, did you get that? A mailing address? Can you please provide me that?
[AGENT][NEUTRAL] Our mailing address is [PII].
[AGENT][NEUTRAL] 89
[AGENT][NEUTRAL] 50
[AGENT][NEUTRAL] In Oklahoma City, Oklahoma.
[AGENT][NEUTRAL] 73124.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I'm asking a mailing address. Is it right? [PII].
[AGENT][POSITIVE] [PII], OK, I'm so sorry.
[CUSTOMER][NEUTRAL] Mhm. OK. That's OK.
[AGENT][NEUTRAL] Sorry, it was cutting in and out so I couldn't hear. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] One moment while I pull that up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like I have [PII] in [PII].
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]. Is that right? And what is the PFL for the appeal?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Um, you have 30 days. You need to give it up to 30 days, and since that has been met, you can file an appeal.
[AGENT][NEUTRAL] And then you would send it to.
[CUSTOMER][NEUTRAL] Only 30 days.
[AGENT][NEUTRAL] You have, yeah, you've already met the the 30 days, so you can file an appeal since it's been 30 days.
[CUSTOMER][NEUTRAL] Mhm. And what is the TFL for appeal?
[AGENT][NEUTRAL] You would send it to the, to the [PII].
[CUSTOMER][NEUTRAL] No, I'm asking family filing limit to send that bill.
[AGENT][NEGATIVE] Oh, I'm so sorry, ma'am. Uh, there is no timely filing.
[CUSTOMER][NEUTRAL] OK, got it. And we need to attach any additional information?
[CUSTOMER][NEGATIVE] Deceptive
[AGENT][NEUTRAL] Um, no, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Could you please provide me the call reference number for this call?
[AGENT][NEUTRAL] So we don't have call reference numbers, but you can use my name and my last initial which is [PII], and today's date.
[CUSTOMER][NEUTRAL] And do you have a fax number?
[AGENT][NEUTRAL] Our fax number is [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, and that's all for today. Thanks for your assistance. Have a great day.
[AGENT][POSITIVE] Thank you so much for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.